People with chronic kidney disease may reach a point when their kidneys are doing only a small fraction of their normal work. This is called kidney failure, or end-stage renal disease (ESRD). When kidney function drops this low, treatment becomes a matter of life or death. If you are nearing this point, you may need to decide what treatment you want. The two main choices are dialysis and kidney transplant. Each has pros and cons you'll want to think about as you make your decision.

Dialysis
Dialysis is a process that filters your blood and removes extra fluids when your kidneys can no longer do this. There are two basic types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis circulates your blood through a machine called a dialyzer to do the work of your kidneys. The filtered blood is then returned to your body. This process takes about 4 hours and is usually done 3 times a week. Some people opt for 2-hour sessions done 6 times a week.

Hemodialysis is usually done at a dialysis center by medical professionals

Pros of hemodialysis

Cons of hemodialysis

It's done by experts, so the chance of infection is lower than peritoneal dialysis.

You don't have to do it every day like peritoneal dialysis.

You'll meet other people who go to the dialysis center.

There may be problems accessing a vein.

You have to go to a dialysis center and are tied to a fairly set schedule.

You may feel tired the day of your treatment.

You'll have to follow a strict diet.

In some cases, dialysis can be done at home with the aid of a trained helper.

Peritoneal dialysis uses the lining of your abdomen to filter your blood. It must be done every day, but you can do it yourself. A surgeon will implant a soft tube in your abdomen. You'll use this access to add and remove dialysis fluid, which helps clean your blood.

You may have a choice of:

Continuous ambulatory peritoneal dialysis (CAPD). This doesn't require a machine, so it can be done almost anywhere. Typically, you need to do at least 4 fill-and-drain cycles a day, each lasting 4 to 6 hours. One fill can be left in overnight.

Continuous cycler-assisted peritoneal dialysis (CCPD). This method uses a machine that does 3 to 5 exchanges at night while you sleep. In the morning, the last fill is left in for the entire day. Sometimes one more exchange is done mid-afternoon to increase the amount of waste removed.

A combination of CAPD and CCPD.

Pros of peritoneal dialysis

Cons of peritoneal dialysis

You can do it yourself in any clean place.

You can do it on your own schedule as long as you do the correct number of exchanges each day.

Your diet will be less limited than if you were on hemodialysis.

It has to be done every day without fail.

You'll spend a couple of hours each day draining and replacing dialysis fluid.

There's a risk of getting a serious abdominal infection (peritonitis).

Transplant
Kidney transplant is probably the best choice if you are in good general health and are able to find a matching kidney. Getting a healthy kidney can help you feel well again.

For a transplant to succeed, the new kidney has to be a close match with your own tissue. If you can't find a living donor, you will have to wait for a kidney from a deceased donor. This can take months or years. You will have to have dialysis while you wait.

Even with a close match, you'll have to take strong medicines to keep your body from rejecting the new kidney. These medicines, called immunosuppressants, increase your risk of infections and cancer. They can also cause long-term side effects, such as osteoporosis.

Pros of transplant

Cons of transplant

You'll have a more normal life than you would on dialysis.

You'll be freed from a dialysis schedule.

Your diet won't be as limited as if you were on dialysis.

It requires major surgery, which has risks.

Anti-rejection drugs have serious complications.

If your body rejects the new kidney, you'll need another transplant or dialysis.

How can I decide on the right treatment?
You can probably take some time to make your decision.

Talk to your doctor about your choices. You may have health issues that make one option better for you than another.

Discuss your choices with your family and friends.

Talk to people who have made the choices you are considering. Visit a dialysis center, or ask your doctor to introduce you to someone who's had a transplant.

By Lila Havens, Staff WriterCreated on 02/20/2008Updated on 08/31/2011